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Long-term
Treatment with Adefovir Dipivoxil Is More Cost Effective Than Lamivudine
for HBeAg-negative Patients with Chronic Hepatitis B The aim of the present study was to estimate the cost-effectiveness of long-term therapy with adefovir dipivoxil (ADV) [Hepsera] or lamivudine (LAM) [Epivir-HBV] as therapies for patients with HBeAg-negative chronic hepatitis B (CHB). A decision analysis model has been designed for a panel of experts to perform a cost effectiveness analysis of LAM (100 mg/daily) and ADV (10 mg/daily) over three years of therapy. Data for each strategy were obtained from published clinical trials. Virological response was defined by undetectable HBV DNA. The study was performed from the perspective of the Spanish Public Health System considering the following direct health costs (in US$): drug acquisition, visits, diagnostic or laboratory tests to determine virologic response and HBV drug resistance Results The following table shows the results of the base-case analysis (with a 3% annual discount for costs):
The costs associated with three years therapy with ADV were 2.2 times greater than those of LAM. Virological response achieved with ADV was 2.5 times greater than that of LAM. Despite the higher costs associated with ADV, the incremental cost-effectiveness ratio of ADV versus LAM was lower than the average cost-effectiveness ratios of ADV or LAM. The sensitivity analysis demonstrated the robustness of the model, being the response to ADV and LAM at year 3 the factors that most influence the cost-effectiveness. [The authors conclude] “Long-term treatment with ADV is a cost-effective strategy in patients with chronic HBeAg-negative hepatitis. Therefore, adefovir dipivoxil should be used as a first line treatment due to the high percentage of virological response obtained at year 3 and because its cost per responding patient is lower than that of LAM.” 11/16/05 Reference
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